Wiki Pitocin Question - Out billing company

[Christina Sachs]

Out billing company has been using 96365 (starting in 2009) and 90765 (in 2008) to report the initial administration and first hour of Pitocin during labor and 96366 (in 2009) and 90766 (in 2008) to report additional hours. Recently, we received a refund request from Blue Cross of California for what they paid to us over the past couple years. In their request, they stated that the codes are not intended to be billed by the physician in the facility setting. This caused us to do some extensive research and we found that in the 2008 code book, the description for 90765 & 90766 had changed from 2007 to 2008, stating that they could not be reported when perfomred by a physician in the facility setting. Also, we cannot find any other code to use to report this. Do you have any idea what we can possible use?

 

[FTessaBartels]

You cannot bill

In a facility setting, the facility is charging for the administration ... because it is generally facility staff (i.e. nursing) who is handling this. The physician does not charge anything for this "service" (which, for the physician, mostly just involves writing the order).


F Tessa Bartels, CPC, CEMC